A leading U.S. senator is calling on federal regulators to share the results of an investigation into the dialysis industry, where critics say a "duopoly" has compromised the quality of critical, lifesaving kidney care.
Two companies now own nearly 75% of all U.S. dialysis clinics — nearly 5,600 in total, a CBS News investigation reported earlier this year. Sen. Richard Blumenthal, a Connecticut Democrat, said in an interview with CBS News he is troubled by the "hallmarks of unlawful abuse of market power."
"The government may feel it has no leverage against two companies that provide for almost all the dialysis treatment in the country," Blumenthal said in an interview with CBS News. "But it has failed to use more leverage, including its antitrust powers against those companies."
The FTC, which polices the business world for anti-competitive conduct, had been probing whether the two companies' lock on the market impacted patient care, Blumenthal said, but any findings have not been made public. Blumenthal said he has requested the agency "take appropriate robust enforcement action to remediate issues it has identified and protect patients, including veterans, from misconduct by these companies."
Roughly 500,000 Americans depend on dialysis to stay alive as they wait and hope for a kidney transplant. The centers, where patients come to have their blood filtered offer the only available remedy for most suffering from end-stage kidney disease. Critics of the industry allege the leading companies that provide that care, Fresenius and DaVita, have become too focused on profits.
"This is emergency room care done in the mall," said Tom Mueller, the author of "How to Make a Killing: Blood, Death and Dollars in American Medicine," who spent more than five years studying the dialysis industry. "People are not given the tailored treatment that they need."
The companies have for three decades been creeping towards "a duopoly," according to Ryan McDevitt, a Duke University economist who spoke to CBS News earlier this year about the issue.
"This is the most concentrated health care sector across the entire U.S.," McDevitt said.
The CBS News review of federal data found one-third of dialysis clinics failed to meet federal standards this year — nearly 2,500 of the roughly 7,600 clinics nationwide. The average score was 60 out of 100 possible points.
In separate statements to CBS News, both companies highlighted their performance, saying the data reflects a track record of "exemplary care."
McDevitt argued that Medicare's limits on how much it reimburses clinics per patient have incentivized DaVita and Fresenius to focus on filling chairs to increase their profit margins. Both companies reject that characterization.
Last year alone, DaVita delivered more than 29 million dialysis treatments, earning $391 in revenue per session, and Davita and Fresenius reported a total of $33.7 billion in revenue.
McDevitt said his research found that over the last twenty years, when independent clinics are acquired by DaVita or Fresenius, their transplant referrals drop by about 10%, their patient survival rates fall by 2%, hospitalizations increase by 5%, and infection rates go up by about 12%.
Criticism of the industry has been disputed by the two for-profit companies. Fresenius told CBS News in a statement this summer that the company maintains an "unwavering focus on improving quality of life, strengthening clinical outcomes, and extending the lifespan of those we have the privilege to serve." DaVita said in a statement that its "dedicated clinicians consistently deliver high-quality, individualized care in a complex clinical and regulatory environment."
For years, health surveyors from the Center for Medicare and Medicaid Services (CMS) have conducted routine monitoring of dialysis clinics to assess their performance.
Since 2013, those officials have cited U.S. dialysis centers for more than 115,000 deficiencies, including poor hand hygiene, unsanitary conditions while handling IV medications, and inadequate training.
Fresenius noted that more than 65% of its dialysis centers received three stars or higher on Medicare's five-star scale — a rate the company said is higher than the national average of all U.S. dialysis providers. The company also said its employees "take immense pride in providing best-in-class, high-quality care to our patients."
DaVita said in a statement to CBS News that problems in clinics were "rare and isolated" and represent "exceptions and do not reflect the exemplary care we consistently provide."
"We take every concern seriously, and if we make an error, we work immediately to resolve it," DaVita said in its statement. "To mischaracterize such anomalies as systemic care failures is reckless, fear-mongering, and puts patient well-being at risk."
Blumenthal noted that one group that has seen greater reliance on the for-profit clinics are those who served in the American military. Some 40,000 veterans depend on dialysis to stay alive as they wait and hope for a kidney transplant, the only available remedy for those suffering from end-stage kidney disease.
In his letter to FTC Chairman Andrew Ferguson, Blumenthal called on the agency to "take appropriate robust enforcement action to remediate issues it has identified and protect patients, including veterans, from misconduct by these companies."
"This industry is ripe with predatory, monopolistic potential practices," Blumenthal alleged in the letter, adding that the "anti-competitive anti consumer situation, and it cries out for the kind of investigation that the FTC would do."
In a statement to CBS News, Fresenius said, "We are aware of the inquiry and are fully cooperating with the FTC. As this is an ongoing investigation, we cannot comment any further."
The FTC and DaVita did not immediately respond to requests for comment.
CBS News investigates dialysis concerns
CBS News investigation finds concerns over dialysis centers across U.S.
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